Prescription painkillers are among the most widely used drugs in America. In the decade since New York Times reporter Barry Meier began investigating their use and abuse, he says he has seen the number of people dying from overdoses quadruple — an increase Meier calls "staggering."
"The current statistic is that about 16,000 people a year die of overdoses involving prescription narcotics. ... It's a huge problem. The number of people dying from these drugs is second only to the number of people that die in car accidents," he tells Fresh Air's Terry Gross.
Meier's new e-book, A World of Hurt: Fixing Pain Medicine's Biggest Mistake, is published by The New York Times Co. and explores opiate painkillers and the consequences of long-term use. He focuses in particular on OxyContin — how it came to be prescribed for chronic pain, what the consequences have been, and how it became a street drug.
Meier explains how, in its initial form, OxyContin was designed as a time-released version of oxycodone — meant to ease pain for many hours at a time without interruption. It became a street drug when people looking to get high found a way to get around the time-release design of the pill.
"All you needed to do was to crush it, chew it, grind it down," Meier says, "and basically the entire narcotic pain [reducing] load that was contained within the drug was released immediately, which is why it was [such a] powerful high and such an addictive drug when it was abused that way."
Meier's previous book, Pain Killer, was published in 2003. He explains that for patients, part of the danger when it comes to the long-term medical use of painkillers like OxyContin comes from the body's ability to develop a tolerance for it.
"Unlike many other types of medications where you can be prescribed a dosage and stay on that dosage for a long time," Meier says, "your body adapts to these drugs. "[Essentially], you require more of the [narcotic] to get the same ... effect. And what happens is a steady escalation in dosage, and it can keep going and going and going and going to the point where, after a year or two of treatment, you are on extremely high levels of these drugs."
That doesn't mean, however, that Meier is unilaterally opposed to these narcotics.
"There is no question that these drugs are extremely beneficial," he tells Gross. "They are valuable, vital drugs. There should be no hesitation in their use after conditions like surgery, or accidents, or cancer treatment or end-of-life use. ... [T]he question becomes: How effective are these drugs in long-term treatment of chronic pain?"
On the promotion of OxyContin for chronic pain relief
"The company that produces OxyContin — Purdue Pharma — launched ... an innovative and huge campaign to introduce drugs that had previously been used for cancer treatment into [use for the relief of] general pain. That involved training hundreds of doctors to go out and speak to their medical colleagues about the benefits of these drugs and, most importantly, the FDA allowed Purdue to make an unusual claim ... that because OxyContin was a time-release drug it would be less prone to causing addiction and less attractive to people who abuse drugs. This became part of a steady drumbeat that was sounded by not only the company, but by leading pain experts — that, in fact, with this drug we had what was really a unique new weapon to deal with an age-old problem."
On the first signs of problems with OxyContin
"The first person who sounded the alarm about this was a doctor in Boston. Her name is Jane Valentine, and she was the head of pain treatment at Massachusetts General. In 2003 she had accepted that these drugs were beneficial. She was a soldier in this war on pain, and as she kind of walked around Mass General, she started seeing things that caught her attention. For example, chronic pain patients who were given these drugs started improving. They would improve for a while, and suddenly their improvement would stop. Their pain would return. They would lose function, or the improvement in function they had achieved would be lost, and she began to wonder why this was going on. That led her to start studying animal tests involving these drugs, and basically began to lead her to question whether these drugs were really beneficial for patients in the long term."
On the side-effect of becoming disengaged from life
"I had a doctor who I greatly respect who said, 'We thought the great problem with these drugs is addiction. What we didn't realize [was] that the people who take them would opt out of life.' And you see it across the spectrum: One of the more startling things is in the area of workplace injuries; things like back strains are very common problems. But what folks have discovered is the more patients — workers — who are treated with these drugs for back strain, the longer and longer and longer they stay away from work. In fact, we've kind of created a legion of chronically unemployed people who are dependent on these drugs."
On widespread use of OxyContin in Appalachia
"If you look at the atlas of how drugs are prescribed in different parts of the country, there usually is a pretty straight correlation between the use of narcotic painkillers and areas where you have physical labor jobs, like mining, farming, logging — [places] where people get a lot of back problems and muscle injuries and things of that nature. In many of these areas you have doctors who are generalists; they're not specialists. So most folks are going to a general practitioner — a family doctor — and when they were told that OxyContin was a less abusable drug than drugs that had preceded it, they said, 'Great. This sounds like a good thing for my patients.' So they started prescribing it very heavily."
On the rise of pill mills
"You basically had these pain clinics [with] doctors that supposedly specialized in treating pain. These, in fact, were doctors who had no experience in treating pain. These are essentially clinics where you could walk in and the doctor would say, 'How do you feel?' 'I'm in pain. I think OxyContin would work for me.' And the doctor would write your prescription. You would pay cash for the appointment, and the cycle would start. And these ... proliferated throughout the U.S."
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